PROTECTING COGNITION AND INCREASING EQUITY THROUGH “COGNITIVE IMPACT ASSESSMENTS”

Abstract Today’s societies are characterized by increasing complexity, in which unimpaired cognitive performance is vital to navigate and participate, as well as to retain independence at older ages. Addressing the challenge of improving population brain health has mostly been considered from a dementia risk reduction perspective as identified by the Lancet Commission on dementia. However, risk factors with immediate harm to cognitive functioning, such as shift work or insufficient sleep are currently not explicitly accounted for. As exposure to these risk factors accumulates across the life course, we can expect substantial consequences for later-life brain health. We argue that, in policy and practice, systematic measures should be introduced to protect individuals from harms to their everyday cognitive functioning, and enable them to optimize cognitive performance throughout the life course. On behalf of the international multidisciplinary BRAINHEALTH-POLICY group, we explore the concept of a ‘cognitive footprint’ of policies with exemplars from current legislation and policy that either implicitly affect cognition, or explicitly address effects on individuals’ cognition. We suggest recommendations for systematic pre-intervention ‘cognitive impact assessments’ in fields such as medicine, where drug trials should include cognition as important secondary endpoint, and work, where labour laws should explicitly account for possibly harmful effects of certain work conditions to cognition. Besides immediate protective effects, we expect ‘cognitive impact assessments’ to have potential for long-term cognitive benefits on a population level as well as improve brain health equity by enabling individuals to reach optimum cognitive performance, with associated wider health benefits.

microbiome diversity (Chao1,Inverse Simpson,Shannon) or individual species at Genus level (ldm-med, permanovamed).Differential abundance analysis across education groups was conducted (ANCOM-BC, DESeq2).Result: After exclusion of participants with PD, below age 50, or with missing data, n=256 participants (n=58 with MCI) of the Luxembourg Parkinson's Study were eligible for analysis (M[SD] Age=64.7[8.3]years).Education (16+ compared to 0-10 years of education) had a natural direct effect of NDE=0.36 (P<.01) on MCI, Chao1 included as mediator.We did not find significant mediation by gut microbiome composition or individual species.

Conclusion:
Our findings indicate direct effects of education not mediated by the gut microbiome.Taxonomic analysis suggests a signature linked to lower risk of dementia in higher educated individuals.Longitudinal research is needed to investigate associations over time.Age-related hearing loss is a predictor of cognitive impairment and dementia.The mechanisms of the observed associations are unclear but could involve depletion of cognitive reserve, the occupation of cognitive resources, and lack of sensory input to the brain.Hearing loss may therefore represent a preventable or treatable causative risk factor for dementia.Indeed, many studies report on lower rates of cognitive decline among hearing aid users when compared to non-users.However, most investigations to date have been observational or with relatively short follow-ups, thus precluding clear interpretations of the underlying mechanism.In our study using UK Biobank data with n=502,386 participants followed up from ~2008 to 2021, we emulate a randomised clinical trial to probe the role of initiating the use of hearing aids in people with conductive hearing loss or with self-reported hearing difficulties in the diagnosis dementia.Diagnosis of dementia was ascertained through hospital and death records, and selfreports in such a way as to increase the positive predictive value.Among participants with hearing loss or hearing difficulties, 2,914 (2.1%) were diagnosed with dementia, compared to 4,982 (1.4%) in those without hearing loss or hearing difficulties.Additional results on the relationship between hearing aid use and dementia, and stratified analyses by sex/gender and ethnicity will be presented.We discuss the modifiability of hearing loss and recommend studies with longer follow-ups to determine the efficacy of hearing loss interventions in reducing the risk of cognitive decline and dementia.

PROTECTING COGNITION AND INCREASING EQUITY THROUGH "COGNITIVE IMPACT ASSESSMENTS"
Anja Leist 1 , Ariane Bertogg 2 , and Skerdi Zanaj 3 , 1. University of Luxembourg, Esch-sur-Alzette, Luxembourg, 2. Ludwig-Maximilians-Universitaet Muenchen, Munich, Bayern, Germany, 3. University of Luxembourg, Luxembourg, Grevenmacher, Luxembourg Today's societies are characterized by increasing complexity, in which unimpaired cognitive performance is vital to navigate and participate, as well as to retain independence at older ages.Addressing the challenge of improving population brain health has mostly been considered from a dementia risk reduction perspective as identified by the Lancet Commission on dementia.However, risk factors with immediate harm to cognitive functioning, such as shift work or insufficient sleep are currently not explicitly accounted for.As exposure to these risk factors accumulates across the life course, we can expect substantial consequences for later-life brain health.We argue that, in policy and practice, systematic measures should be introduced to protect individuals from harms to their everyday cognitive functioning, and enable them to optimize cognitive performance throughout the life course.On behalf of the international multidisciplinary BRAINHEALTH-POLICY group, we explore the concept of a 'cognitive footprint' of policies with exemplars from current legislation and policy that either implicitly affect cognition, or explicitly address effects on individuals' cognition.We suggest recommendations for systematic pre-intervention 'cognitive impact assessments' in fields such as medicine, where drug trials should include cognition as important secondary endpoint, and work, where labour laws should explicitly account for possibly harmful effects of certain work conditions to cognition.Besides immediate protective effects, we expect 'cognitive impact assessments' to have potential for long-term cognitive benefits on a population level as well as improve brain health equity by enabling individuals to reach optimum cognitive performance, with associated wider health benefits.

COGNITION MEASURES AND FINDINGS IN THE NATIONAL SOCIAL LIFE, HEALTH, AND AGING PROJECT
Chair: Linda Waite Discussant: Dawn Carr Good cognitive function is an important component of health at any age.Certain domains of cognition tend to decline with age and rates of change vary dramatically across individuals and across social groups.This Symposium examines a commonly-used clinical measure of cognition, the Montreal Cognitive Assessment, adapted for survey use (MoCA-SA) and administered in two rounds of the National Social Life, Health andAging Project (2010 and2015).It focuses especially identifying and evaluating differential functioning of the MoCA-SA across racial and ethnic groups, across modes of administration of the measure, within intimate dyads and as linked to sensory function.Iveniuk and colleagues examine race difference and find that 7 measures, out of the 18 used in NSHAP's MoCA, formed a scale that was more robust to racial bias and suggest use of this modified measure to compare racial groups.Piedra and coauthors construct an abbreviated MoCA-SA (Spanish version) that compared favorably with the long form MoCA across the different grouping and showed predicative validity with consequential outcomes associated with cognitive decline.Pudelek and colleagues examine mode of assessment.web, phone, and PAPI or in-person interviews and describe an analytic strategy for obtaining a measure comparable across modes.Meiyi Li and Yiang Li find that women's cognitive impairment adversely affects their partner's social connectedness but husband's impairment does not.Zhong et al find that odor identification was associated with some domains of cognition with differences in that association by age, gender, or race, but not by education.

RACE/ETHNICITY AND THE MEASUREMENT OF COGNITION IN NSHAP: RECOMMENDATIONS FOR ROBUSTNESS
James Iveniuk 1 , Haena Lee 2 , Selena Zhong 3 , Jocelyn Wilder 3 , Gillian Marshall 1 , Boyle Patricia 4 , Lissette Piedra 5 , and Alicia Riley 6 , 1. NORC at the University of Chicago,Chicago,Illinois,United States,2. Sungkyunkwan University,Seoul,Republic of Korea,3. NORC,Chicago,Illinois,United States,4. Rush Alzheimer's Disease Center,Chicago,Illinois,United States,5.University of Illinois at Urbana,Illinois,United States,6. UC Santa Cruz,Santa Cruz,California,United States In this study, we interrogate measurement of cognition by race, in order to move towards a less-biased and moreinclusive set of measures for capturing cognitive change and decline in older adulthood.We use data from Round 2 (N=3377) and Round 3 (N=4777) of the National Social Life Health and Aging Project (NSHAP), and examine the study's version of the Montreal Cognitive Assessment (MoCA).We employ exploratory factor analyses to explore configural invariance by racial/ethnic group (Non-Hispanic White, Non-Hispanic Black, Hispanic, All else), and then log-likelihood tests of scalar and metric invariance.Using modification indexes we identify items that seem robust to bias by race.We test the predictive validity of the full (18item) and short (7-item) scales using self-reported dementia diagnosis, Instrumental Activities of Daily Living (IADLs), proxy reports of dementia death, and National Death Index (NDI) reports of dementia death.We found that 7 measures, out of the 18 used in NSHAP's MoCA, formed a scale that was more robust to racial bias.The shortened form predicted consequential outcomes equally well, compared to NSHAP's full MoCA.The short form was also highly correlated with the full form, and displayed lower test-retest correlation between Round 2 and 3.Although sophisticated structural equation modeling techniques could be useful for assuaging measurement invariance by race in NSHAP, the shortened form provides a quick way for researchers to carry out robustness checks -to see if the disparities and associations they document are 'real' or the product of artifactual bias.